Basic Information
| Provider Information | |||||||||
| NPI: | 1760039218 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REDITO | ||||||||
| FirstName: | TRISHA MAE | ||||||||
| MiddleName: | PAREDES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2580 SAINT CLOUD DR | ||||||||
| Address2: | |||||||||
| City: | SAN BRUNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940661741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6505809453 | ||||||||
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| Practice Location | |||||||||
| Address1: | 795 WILLOW RD BLDG 332 | ||||||||
| Address2: | |||||||||
| City: | MENLO PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940252539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503241470 | ||||||||
| FaxNumber: | 6503244149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2019 | ||||||||
| LastUpdateDate: | 08/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.